Patriot K-Nine Behavioral Client Intake Form
After you fill out this request, we will book your appointment based on availability of trainers. If you would like to you can contact us at (919) 888-3870 or info@patriotk-nine.com.

Please allow 24-48 hours for a response, if you have not heard back from us by then please give us a call as there maybe a technical issue with Google Forms. Thank You.
Name (First and Last) *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
City
Your answer
How did you hear about us? *
Preferred contact method *
Required
Preferred Appointment Day *
Is your pet current on vaccinations? Dogs that are not current will not be seen until they are *
Pet Name *
Your answer
Birthdate or Approximate Age *
Your answer
Pets Weight
Your answer
Gender
*Females that are not spayed and in heat will NOT be seen unless they are wearing a diaper or other protective cover for hygiene purposes
It is your responsibility to clean up after your dog if you do not adhere to our policy
Breed *
Your answer
Has your dog ever bitten a human? *
If yes, please explain the severity:
Your answer
Has your dog ever bitten another dog? *
If yes, please explain the severity:
Your answer
Is your Dog currently on medication? *
Your answer
Veterinarian
Your answer
Type of Training You Are Interested In *
Required
Please Describe the issue(s) you are having, approximately how long they have been going on, any attempts you've made to correct them, and how you would like us to assist you. The more specific you can get the better will be able to assist you. *
Your answer
Once we've booked your appointment, you understand that we have a $25 NO SHOW fee to re-book your appointment. That means, we understand life happens. Please contact us within 24hrs to let us know you were unable to make your appointment. *If you appointment is May 1st at 10 am and you no show, you have until May 2nd at 10am to contact us. If you call May 4th at 3pm to set a new appointment, there will be a $25 fee. *
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